Sunday 30 July 2017

2017 - 10 Things About The Veterans Choice Program

10 Things About The Veterans Choice Program

Doctor and patient shaking hands
The Veterans Choice Program (VCP) is a benefit that allows eligible Veterans to receive health care from a community provider rather than waiting for a VA appointment or traveling to a VA facility.
1. Am I eligible for the Veterans Choice Program?
To be eligible for the program, you must be enrolled in VA health care and must also meet at least one of the following criteria:
  • You are told by your local VA medical facility that you will need to wait more than 30 days for an appointment.
  • You residence is more than a 40 mile driving distance from the closest VA medical facility with a full time primary care physician.
  • You need to travel by air, boat, or ferry to the VA medical facility closet to your house.
  • You face an unusual or excessive burden in traveling to the closest VA medical facility based on a geographic challenge, environmental factor, medical condition, or other specific clinical decisions. Staff at your local VA medical facility will work with you to determine if you are eligible for any of these reasons.
  • You reside in a State or a United States Territory without a full-service VA medical facility that provides hospital care, emergency services and surgical care, and reside more than 20 miles from such a VA medical facility. Note: This criterion applies to Veterans residing in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands. Also note that some Veterans in New Hampshire reside within 20 miles of White River Junction VAMC and are therefore not eligible for the Veterans Choice Program.
2. What if I think I am eligible?
  • Call the VCP Call Center at 866-606-8198 or visit the Veterans Choice Program website to verify eligibility and set up an appointment here.
3. Can I call my non-VA doctor to make an appointment?
  • No, please call the VCP call center at 866-606-8198 to verify eligibility and set up an appointment.
4. How is the 40 mile calculation determined?
  • This calculation is based on the driving distance from your permanent residence (or active temporary address) to the closest VA facility, including Community-Based Outpatient Clinics and VA Medical Centers. You are eligible if you live more than 40 miles driving distance from the closest medical facility that has a full-time primary care physician.
5. If I am eligible for the Veterans Choice Program, can I receive Beneficiary Travel for travel to appointments with a VCP provider?
  • Yes, the Choice Act does provide funding to pay for travel to VCP providers for Veterans who are eligible for Beneficiary Travel. However, it did not provide any new Beneficiary Travel eligibility.
6. If I didn’t get my Choice Card or I lost my Choice Card, what do I do?
  • You do not need your Choice Card to access the VCP. If you didn’t receive a Choice Card or lost your Choice Card, simply call 866-606-8198 to find out if you are eligible and to make an appointment.
7. How do I get my prescription filled if I use the Veterans Choice Program?
  • The community provider you see through the VCP can issue a prescription for up to a 14 day supply of a national formulary drug. You may have the 14 day supply filled at any non-VA pharmacy of your choosing.
  • Prescriptions can be reimbursed through the Business Office/Non-VA Care Coordination Office at VA facilities. This reimbursement may take 30-45 days to process, and requires a copy of the prescription and the original receipt. Veterans cannot be reimbursed at the VA Pharmacy.
  • For prescriptions needed past 14 days, please follow standard procedures to fill a prescription at the VA pharmacy.
8. If I use the Veterans Choice Program, does that affect my VA health care?
  • No, not at all. You do not have to choose between the two. The VCP is here to make it easier to access the care you need. VA is building a high-performing integrated health care network to deliver the best of VA and the community. This integrated network will give Veterans more choices to access care and ensure care is delivered where and when you need it.
9. What is my responsibility for co-payments to my other insurance?
  • Nothing. VA is now the primary coordinator of benefits for VCP, so you are only responsible for your VA copayment.
  • Your VA copayment will be determined by VA after the care is provided. VA copayments will be billed by VA after the appointment.
10. How does the new VCP extension law affect me?
  • Public Law 115-26, enacted April 19, 2017, made three key changes to help improve the VCP. The law removed the expiration date for the program, made VA primary coordinator of benefits for services provided to you, and it removed barriers with sharing necessary health information with community providers.
More Information
  • Please refer to the Veterans Choice Program website for more information about the program, its benefits, and eligibility criteria here.
  • Providers interested in participating must establish a contract with one of the contractors, Health Net Federal, or TriWest Healthcare Alliance. For more information, about how to participate please visit Veterans Choice Program website for providers.

Monday 10 July 2017

2017 - The Global Trend in Health Expenses and Current Electronic Medical Records

Veterans of War, the global trend in health expenses and current Electronic Medical Records.

                                       Eduardo C. Gerding

The purpose of this article is to point out the increase in health expenses worldwide and the possibility of improving benefits through the use of Electronic Medical Records in active and retired military personnel but above all in the universe of our Veterans of war.

Health expenditures

In a decade, nearly $1 in every $5 spent in the United States by 2024 will be on health care, and this spending grew faster than the entire economy. 19

Pie chart showing the spending percentages invested in the UK for Fiscal Year 2017. Health occupies 18 percent

In Argentina, health spending in 2014 was 2.65% of GDP, a drop of 0.09 points compared to 2013, at which time spending represented 2.74% of GDP.

In 2014, Argentina spent 6.92% of its total public expenditure on health, while the previous year had devoted 7.72%, five years earlier to 17.13% and if we go back ten years ago the percentage was 16.92% of public spending, that is to say, the proportion destined to health has fallen in recent years.

In reference to the percentage that implies the investment in sanity with respect to the governmental budget (public expenditure), Argentina is in position 154.

In 2014, public spending on health in Argentina was 262 Euros per inhabitant and in 2013, 298 Euros. Based on public expenditure on health per capita, Argentina ranks 74 out of 192 published countries.

In 2014 the public expenditure per capita in sanitation in Argentina was 244 Euros. It is the total expenditure on health divided among all its inhabitants, regardless of their age or situation. Currently, according to its public expenditure on health per capita, Argentina is ranked 74 out of 192 published. 2

Interesting studies have been done comparing the health systems of Argentina, Canada and the USA. 12

Health spending on US war veteransHow is spending on military personnel health divided?

In 2012 at least, the expenses of the US Department of Defense were divided into three areas: $ 32 billion for the TRICARE health program that provides assistance to active military personnel, $ 19.7 trillion for the TRICARE Lifetime Program Medicare supplemental insurance for retired military personnel and then a mix that includes payment to military hospitals and health workers. The program covers 9.6 million Americans.

Unlike TRICARE that hires providers in the private sector, the Veterans Administration is a single payer system and follows the NHS guidelines in which the government owns the hospitals and pays the bills. 11,16,20

Health expenditures for military personnel are increasing faster than inflation. 11

How much does the US spend on its war veterans? In 2014 they spent $ 154 billion representing 4 percent of the federal budget. This included veteran benefits, hospital medical care, housing, education, training, and rehabilitation. 17

War veterans have an increased risk of suicide, homelessness, mental health disorders such as Post Traumatic Stress, disabilities, and even unemployment. 17

On the other hand, military spending accounts for 17 percent of federal spending; A little more than half of the spending at the discretion of 2014. Military expenditures include the basic defense budget, nuclear weapons, international assistance and Overseas Contingency Operations. 17

Spending on the Military and on Veterans in 2014.

In a very tough article Jasmine Tucker asked: What does it say about our priorities as a nation that for every dollar the U.S. spends on its military this year, it will spend less than 24 cents caring for its veterans? 17

Military personnel and access to medical providers in the US

The active duty military personnel has priority of assistance.

In 1866 the Civil Medical Assistance Program of the Uniformed Services (CHAMPUS) was created and it allowed the Secretary of Defense to contract civilian providers.

In 1980 came the Reform to the CHAMPUS Initiative (CRI). Under the latter, three types of benefits were offered to the patient: 1) TRICARE Prime (possibility of choosing provider), 2) TRICARE Extra (offered a list of providers) and 3) TRICARE standard (could choose provider but costs were higher ). The latter was also offered to retired staff.

With the TRICARE system USA was divided into 12 health regions with a responsible agent in each of them. Seven civilian welfare providers were hired to meet the needs of the 12 regions.

In 2014, Senate Committee Chairman Bernie Sanders (Senator for Vermont) and Senator John McCain announced a bill that expanded veterans' access to various health facilities and increased reliability In the Department of Veterans Affairs.

Basically the Sanders-McCain Bill what was established was: 13,14   

  1. War Veterans who have a long waiting time or who live more than 40 km. away from a Veterans Administration´s provider will be authorized to would allow veterans to seek private care. An audit revealed that there were 75,000 war veterans who had to wait more than three months to be assisted by a Veterans Administration professional. It also would require the VA to establish disciplinary procedures for employees who knowingly falsify wait time data.
  2. US $ 500 million would probably be authorized to hire more doctors and nurses.
  3. The Senate bill would require the VA to post on the Internet current wait times for appointments in primary and specialty care at each VA medical center.
  4. Construction of 26 medical centers in 18 states. 6

Electronic Medical Record systems (EMRs)

An Electronic Medical Record system is an accumulation of digitized information from a patient population. Data include clinical history, prescriptions, allergies, vaccination, laboratory analysis, imaging studies, vital signs, age, weight, demographic information and billing. The paperwork is eliminated and the information kept up to date.

According to the US Veterans Administration This system improves its efficiency by 6% each year elapsed.

Systems have been implemented (Intermedic Trip Tix) that automatically read the written by the health agents during the ambulance transfer and turn it into digital information.

With the RME it improves the quality of care. It would serve to reduce costs primarily in large institutions and not so much in small offices. According to a study by the Annals of Internal Medicine reduces the hours of identification of a patient from 130 to 46 hours. 3

Professionals can synchronize their cell phones with EMRs. The threats to EMRs are: a) By personnel or hackers, b) Environmental disasters (hurricane, fires), c) Technological failures and traffic accidents.

The general public has not received the EMRs completely because of the possibility that the government may use these data beyond the purpose for which they were created or that the information falls into the wrong hands. Several countries have issued very strict laws in this regard. The European Union made a General Regulation of Data Protection. 4

In UK, the NHS (similar to our PAMI) has pledged not to use more papers and to register all health data as EMR by 2020 (Five Year Forward View, NHS England October 2014) 4

A survey conducted in London in 2015 on 2761 patients reported that 79% were concerned about RME safety. However 55% support this technique. 9


In the USA. The MiCare System not only effectively manages the healthcare demands but also controls the expenses they generate. It has two components: a) The direct cost of care and b) The indirect administrative cost. There is also the RelayHealth founded in 1999 by Giovanni Colella with his headquarters in Atlanta, Georgia. 8.10

Recall that in October 2016 the Legislature of Buenos Aires unanimously approved the law to create the Integrated System of Electronic Clinical Histories (ECH), which is already implemented in 10 community centers (CeSAC) and that by the end of 2017 will be effective in 43 Districts. 1

 Electronic Medical Record screen

US Secretary of War Veterans Affairs Dr David J. Shulkin announced on June 5 of this year his decision to implement the EMR for the Department of Veterans Affairs. 18


The MHS GENESIS is the last word in EMR that has acquired the US Department of Defense. It holds all medical and dental records. It will replace various systems and will comprise the Armed Forces Longitudinal Health Technology Applications (AHLTA), the Joint Compound System (CHCS) and the Joint Medical Theater Program (TMP-J). The Office of Management of the Joint Medical Operational Information System (JOMIS) is responsible for the operation of the MHS GENESIS.

The acronym IOC refers to Initial Operational Capacity and describes the first destinations that will receive the MHS GENESIS. These are: Army Madigan Medical Center, Bremerton Naval Hospital, Oak Harbor Naval Hospital and Fairchild Air Force Base (92nd Medical and Dental).

Those patients who move to destinations where MHS GENESIS is not yet applied may continue to use the RelayHealth / MiCare or Tricare systems online.


 At the MHS GENESIS Patient web patients will be able to:
1.      Manage medical and active duty dental appointments.
2.      View notes from the clinical visits and certain lab/tests results such as blood tests.
3.      Request the prescription renewal of medications.
4.      Exchange secure messages with the health team.
5.      Monitor the health information of the holder and their relatives and corroborate the care profile.

6.      Complete a pre-visit active duty dental health questionnaire online.
7.      Look up information related to their health concerns and medications.
8.      View, download, transmit and print their health data.
9.      Receive alerts about their medical exams and connect with health education links.

The patients can access the MHS GENESIS portal:
1.      From 0-12 years: Parents or caregivers will have access to the child's records.
2.      From 13 to 17 years: To enter require a password.
3.      More than 18 years: To enter require a password
4.      National Guard / Reserve / Retired: Enter your password.
5.      Personnel who have been separated from force but not retired: That is, personnel who have completed their military service and are on their way to retirement. They are allowed a period of six months in which they keep their password.
6.      Deaths: The account of deceased personnel is deactivated but
Your family members can still access the portal.

The password is obtained through the Human Resources Data Center of the US Department of Defense.


1.     Aprobaron la ley de historias clínicas electrónicas para los hospitales públicos de la Ciudad http://www.telam.com.ar/notas/201610/168568-legislatura-portena-salud-hospitales-historia-clinica.html
2.      Argentina-Gasto Publico en Salud http://www.datosmacro.com/estado/gasto/salud/argentina
3.      Baron, Richard MD- Quality Improvement with an Electronic Health Record: Achievable, but Not Automatic- 16 October 2007 Annals of Internal Medicine Volume 147 • Number 8
4.      Electronic Health Record https://en.wikipedia.org/wiki/Electronic_health_record
5.      Electronic Health Record-Houses of Parliament http://researchbriefings.files.parliament.uk/documents/POST-PN-0519/POST-PN-0519.pdf
6.      Herb, Jeremy-Sanders-McCain strike VA deal -06/05/2014. http://www.politico.com/story/2014/06/bernie-sanders-john-mccain-va-deal-107491
7.      MHS GENESIS-Health.Mil https://health.mil/MHSGENESIS
8.      MiCare https://eclaims.micaresvc.com/
9.      Papoutsi, C, J. E. Reed, C. Marston, R. Lewis, A. Majeed, D. Bell, ‘Patient and public views about the security and privacy of Electronic Health Records (EHRs) in the UK: results from a mixed methods study’, BMC Medical Informatics & Decision Making, 2015, 15 (1).
11.  Roy, Avik-How Health-Care Spending Strains the U.S. Military- Forbes-March 12, 2012
13.  Simon, Richard-A primer on how the VA crisis broke the usual congressional gridlock .Los Angeles Times, June 10, 2014. http://www.latimes.com/nation/nationnow/la-na-veterans-affairs-va-legislation-20140610-story.html
14.  Simon, Richard, Zarembo, Alan-VA audit sparks outrage in Congress over long waits for medical care-Los Angeles Time, June 24, 2017-
15.  Total Pie Chart UK for 2017 http://www.ukpublicspending.co.uk/piechart_2017_UK_total
17.  Tucker, Jasmine- How Much Do We Spend on Our Nation’s Veterans?-National Priorities Project-Nov 11, 2014 https://www.nationalpriorities.org/blog/2014/11/11/how-much-do-we-spend-our-nations-veterans/
18.  US Department of Veterans Affair-News Release-Secretary's Blog, Top Stories by OMR-June 5, 2017 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=2914